Provider Demographics
NPI:1831788868
Name:GREENE, WILLA PAULETTE
Entity type:Individual
Prefix:MRS
First Name:WILLA
Middle Name:PAULETTE
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WILLA
Other - Middle Name:PAULETTE
Other - Last Name:REDDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2194 STADIUM RD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-6159
Mailing Address - Country:US
Mailing Address - Phone:803-325-5483
Mailing Address - Fax:
Practice Address - Street 1:2194 STADIUM RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-6159
Practice Address - Country:US
Practice Address - Phone:803-325-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator